Provider Demographics
NPI:1245005966
Name:EVANS, JENNIE ANNE (RN60828845)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:ANNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN60828845
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:ANNE
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5400 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7049
Mailing Address - Country:US
Mailing Address - Phone:360-759-1500
Mailing Address - Fax:360-759-1515
Practice Address - Street 1:5400 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7049
Practice Address - Country:US
Practice Address - Phone:360-759-1500
Practice Address - Fax:360-759-1515
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60828845163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health